Healthcare Provider Details

I. General information

NPI: 1922582923
Provider Name (Legal Business Name): HEVYLLA TERLAU PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 MONTGOMERY RD STE 210
CINCINNATI OH
45212-2280
US

IV. Provider business mailing address

4805 MONTGOMERY RD STE 150
CINCINNATI OH
45212-2280
US

V. Phone/Fax

Practice location:
  • Phone: 513-241-2370
  • Fax: 513-721-4555
Mailing address:
  • Phone: 513-241-2370
  • Fax: 513-721-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberP.09009
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: